Physicians Criticizing Physicians to Patients
- 847 Downloads
Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being.
This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians.
Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians.
Twenty community-based oncologists and 19 family physicians had encounters with SPs.
Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments.
Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient’s previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians.
This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
KEY WORDSphysician communication teams criticism cancer
The data collection for this study was funded by the US National Cancer Institute R21CA124913, Cleveland G Shields PhD, PI, and Jennifer J Griggs MD, Co-Investigator. Analysis and writing for Diane Morse MD was funded by United States National Institute of Mental Health T32 MH18911, PI Eric Caine, MD; National Institute on Drug Abuse 1K23DA031612-01A1; and the McGowan Charitable Fund, 524475.
Thanks to Ronald Epstein MD and Richard Frankel PhD for their critiques and input on this manuscript.
Conflicts of Interest
The authors declare that they do not have any conflicts of interest.
- 3.Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica. 2009;53:143–151. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2008.01717.x/full accessed April 6, 2013.
- 5.Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Affairs. 2010;29:1489–1495. Retrieved from http://content.healthaffairs.org/content/29/8/1489.short. accessed April 6, 2013.
- 6.Rosenstein A. Managing disruptive behaviors in the health care setting: process, policy, prevention and intervention. Adv Psychol Res. 2009;72:1–14.Google Scholar
- 7.Rosenstein AH, O’Daniel M. Original Research: Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians: Nurses, physicians, and administrators say that clinicians’ disruptive behavior has negative effects on clinical outcomes. American Journal of Nursing. 2005;105:54. Retrieved from http://journals.lww.com/ajnonline/Abstract/2005/01000/Original_Research__Disruptive_Behavior_and.25.aspx. Accessed April 6, 2013.
- 8.Samenow CP, Spickard Jr A, Swiggart W, Regan J, Barrett D. Consequences of Physician Disruptive Behavior. Tenn. Med. 2007;38–40.Google Scholar
- 9.Weber DO. Poll results: doctors’ disruptive behavior disturbs physician leaders. Phys Exec. 2004;30:6–14.Google Scholar
- 10.AMA Code of Ethics E-9.045. Physicians with disruptive behavior. March 2009. Available at www.ama-assn.org/ama1/pub/upload/mm/code-medical-ethics/ceja-3i09 Accessed April 6, 2013.
- 11.Beckerman J. Personal Communication. Office of Patient- and Family-Centered Care. University of Rochester Medical Center. Rochester NY. March 7. 2013Google Scholar
- 13.National Comprehensive Cancer Network Guidelines for Treatment of Lung Cancer, https://nccn.org. Accessed April 6, 2013).
- 17.Miller W, Crabtree B. Primary care research: a multi-method typology and qualitative road map. In: Crabtree BF, Miller WL eds. Doing Qualitative Research. Sage Publications; 1999:17–18.Google Scholar
- 18.Creswell JW. Qualitative Inquiry and Research Design: Choosing Among the Five Traditions. Thousand Parks Oaks: Sage Publications Inc; 1998:208–9.Google Scholar
- 19.Creswell JW, Maietta RC (2001) Systematic procedures of inquiry and computer data analysis software for qualitative research. In: Salkind NJ, Delbert MC, eds. Handbook of Research Design and Social Measurement (6th ed.,) Thousand Oaks, CA: Sage Publications, Inc; pp. 142–143–184.Google Scholar
- 21.American College of Physicians. American College of Physicians Ethics Manual. Ann Intern Med. 2012;156:76–104.Google Scholar
- 23.Berry W. Minimizing vulnerability to malpractice claims. Elements of Contemporary Practice. Decker Intellectual Properties. 2011;1–11.Google Scholar
- 26.Bowen M. Family Therapy in Clinical Practice. New York: Aronson, Jason Inc; 1985.Google Scholar
- 27.Zwarenstein M, Goldman J, Reeves S (2009) Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 3. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000072.pub2/pdf/standard
- 32.Wu AM, McPhee SJ, Christensen JF. Mistakes in medical practice. In: Feldman MD, Christensen JF, eds. Behavioral Medicine. New York: Lange; 2008:375.Google Scholar
- 34.Kamien BA, Bassiri M, Kamien M. Doctors badmouthing each other. Does it Affect medical students’ career choices? Aust Fam Physician. 1999 Jun;28(6):576–9.Google Scholar